Teaching the craft of operative surgery

(a) Recent changes in practice and organisation of surgery make it even more important than formerly to focus attention on the acquisition of operative skills. Once the elements of good operative technique are inculcated, the trainees need practice to establish and refine the natural skill patterns that convert competence into mastery. As opportunities to acquire practical operative experience diminish in Britain, we should encourage our future surgeons to spend a period in less affluent countries where there is a heavy workload of predominantly open surgery. At present such periods are too often dismissed as 'experience, not training'. (b) Apprenticeship remains the essential element for acquiring the craft skills. Apprenticeship does not imply merely allowing trainees to watch and assist. They must also perform under supervision while being assisted by the master. (c) Craft workshops are valuable adjuncts for formal instruction and 'hands on' experience as a preliminary to continued practice of the skills. They allow the principles of good surgery to be formally stated and reinforced. (d) We do not yet have objective tests of operative skill and should not judge trainees at an early stage, except in their adherence to accepted precepts and by their results. (e) Those of us who are privileged to train the next generation of surgeons should critically assess the standards of our own technique, not just in relation to our surgical success but also to the standards we are passing on to our successors.